By Carson Rolleri, ASCO Communications

In Clinical Cancer Advances 2018: ASCO's Annual Report on Progress Against Cancer, which highlights the most impactful cancer research progress and the importance of federally funded research, ASCO recognized a type of adoptive cell immunotherapy, chimeric antigen receptor (CAR) T-cell therapy, as the Advance of the Year.

The report, which published on January 30, also highlighted important trends in oncology:

• The number of cancer survivors in the United States is growing. Today, 15.5 million Americans—nearly one in 20—are cancer survivors,¹ and experts estimate this population will grow to 26 million by 2040.²
• People with cancer are living longer. About 64% of U.S. patients diagnosed with cancer in 2005 have lived 10 years beyond diagnosis, compared to 35% of those diagnosed in 1975.³
• More treatments are available for patients. In the span of just 1 year, the U.S. Food and Drug Administration (FDA) approved 31 new therapies for more than 16 types of cancer. Among the new approvals are two firsts—an adoptive cell immunotherapy and gene therapy for cancer and a tumor site–agnostic therapy.
• Cancer research is accelerating. The number of medical journal articles with the word cancer in the title quadrupled in the last decade, from about 28,000 in 2007 to 120,000 in 2017.

“When I stand back and look at the year’s worth of research documented in this report, I’m truly excited by the progress we continue to make for our patients,” said John Heymach, MD, PhD, co-executive editor of Clinical Cancer Advances. “If we want to keep up the pace of the past few decades, we need to invest in the broad spectrum of cancer research, from prevention and screening to treatment and survivorship.”

Harold J. Burstein, MD, PhD, FASCO, served as co-executive editor with Dr. Heymach.

The importance of federal investment in research

Launched in 2005, the Clinical Cancer Advances report aims to benchmark the progress made against cancer from year to year. Assembled by an editorial board of 20 ASCO experts in different fields, the report serves as a narrative of the latest top research in cancer prevention, treatment, and survivorship, as well as care trends and themes through all stages of the disease.

The report also showcases the important role of federal funding in sustaining and accelerating the pace of advances made in oncology. More than 25% of the top advances featured in the Clinical Cancer Advances report, including an early investment in adoptive cell immunotherapy which led to the Advance of the Year, were made possible by federal support for biomedical research. ASCO’s supplement to the report, “Setting the Pace of Progress: U.S. Investment in Cancer Research Saves Lives,” provides an overview of the federal funding landscape and showcases how federal funding has spurred some of the latest innovations in cancer prevention and treatment.

“Federally supported cancer research generates the biomedical innovations that fuel the development and availability of new and improved treatments for patients,” said 2017-2018 ASCO President Bruce E. Johnson, MD, FASCO. “We need sustained federal research investment to accelerate the discovery of the next generation of cancer treatments.”

In a recent national survey conducted by ASCO, more than 90% of Americans believe that the U.S. government should dedicate substantial funding to diagnose, prevent, and treat cancer.⁴

The promise of adoptive cell immunotherapy

Adoptive cell immunotherapy allows clinicians to genetically reprogram patients’ own immune cells to find and attack cancer cells throughout the body. In 2017, the FDA approved the first adoptive cell immunotherapy for cancer: tisagenlecleucel, a CAR T-cell therapy to treat children and young adults with acute lymphoblastic leukemia (ALL). With remission rates of over 80% (compared to 30% or less with current standard therapy), CAR T-cell therapy is poised to transform pediatric ALL treatment. A similar CAR T-cell therapy was later approved to treat adults with diffuse large B-cell lymphoma (DLBCL), and there are promising results with a different CAR T-cell therapy for multiple myeloma.

Highlighting the importance of federally funded research, the first clinical trial of CAR T-cell therapy in children with ALL was funded in part by grants from the National Cancer Institute (NCI), and researchers at NCI’s Center for Cancer Research were the first to report on possible CAR T-cell therapy for multiple myeloma. 

Life-extended potential of immunotherapy for lung cancer

Immune checkpoint inhibitors have transformed treatment for advanced non-small cell lung cancer (NSCLC). ASCO estimates that immune checkpoint inhibitors would save 250,000 years of life if all U.S. patients with advanced NSCLC for whom checkpoint inhibitors are currently indicated received the treatment. In addition, one in four patients with newly diagnosed cancer and one in 10 with a previously treated disease may live 10 years beyond diagnosis. The estimates were based on an analysis of clinical trial results and cancer incidence and population data conducted by the ASCO Center for Research and Analytics (CENTRA).

Major trends shaping patient care today

Among other major trends, the 2018 report features paradigm shifts in the treatment of lung, bladder, and prostate cancer, as well as milestones made in precision oncology and patient centered-care.

Precision oncology: In 2017, the FDA granted immune checkpoint inhibitor pembrolizumab accelerated approval to treat any type of solid tumor that has mismatch repair deficiency, a defect that undermines the cell’s ability to repair DNA damage. Pembrolizumab thus became the first cancer treatment to receive a tumor-agnostic indication. The report also highlights promising research on larotrectinib, which targets a rare genomic abnormality, tropomyosin receptor kinase (TRK) gene fusion, and also appears to work across many tumor types. In the past year, the FDA approved 13 new molecularly targeted treatments for cancer.

Patient-centered care: The report spotlights the renewed focus on the emotional and psychosocial needs of patients with cancer from diagnosis through treatment and survivorship. New tools engaging patients in their own care, including online programs for symptom monitoring and psychological support, are showing significant benefits for patients and healthcare systems alike. Patients have also become an important factor in driving biomedical research forward by donating clinical information and tissue samples and helping to design guidelines and clinical trials.

To read more about the Advance of the Year and other notable improvements in oncology, view the full report at asco.org/CCA or in the Journal of Clinical Oncology.

References

1.  American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2016-2017. Atlanta: American Cancer Society; 2016.
2.  Bluethmann SM, Mariotto AB, Rowland JH. Cancer Epidemiol Biomarkers Prev 2016;25:1029-36.
3.  Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2014. April 2017. Available at: https://seer.cancer.gov/csr/1975_2014/. Accessed Jan 12, 2018.
4.  American Society of Clinical Oncology. National Cancer Opinion Survey. October 2017. Available at: https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/ASCO-National-Cancer-Opinion-Survey-Results.pdf. Accessed Dec 22, 2017.